Clinical Nurse Reviewer

Choose a supplier that delivers reliable, personalized service for catheter, incontinence, and bowel management supplies. At Comfort Medical, we believe patients deserve more than products; they deserve both practical assistance and emotional support to navigate their conditions successfully. Living with a chronic condition entails more than just managing day-to-day tasks; it’s about conquering everyday challenges to lead the life they aspire to.

The Clinical Nurse Reviewer plays a crucial role in Comfort Medical by evaluating and assessing medical records, progress notes, and healthcare Certificates of Medical Necessity (also known as CMN’s or Prescriptions) to ensure compliance with industry standards, federal and state regulations, and quality of care. This position requires a strong understanding of medical terminology, healthcare protocols, and attention to detail to maintain the highest standards of patient care and safety.

Review and analyze patient medical records, ensuring accuracy, completeness, and compliance with relevant regulations and guidelines. Collaborate with healthcare professionals, including physicians, nurses and appropriate staff, to ensure receipt of proper documentation. Responsible for understanding and adhering to all Medicare Local and National Coverage Determinations (LCD’s and NCD’s), policy articles, government rules and regulations, and contracted payor policies pertaining to services and products provided. Will work closely with the department Manager and external resources to accurately interpret and explain policy documentation requirements to all company stakeholders. Responsible for navigating between multiple computer-based systems to accurately review audits/appeals as assigned Will identify and communicate deficiencies/discrepancies in documentation while complying with company policies & procedures. Ensure audit/appeal packets are assembled and submitted correctly according to department policies and procedures within the defined timeframe. Effectively communicates with Comfort Medical internal stakeholders clinical need qualifications and regulatory requirements. Serve as a clinical resource for non-medical staff. Support training and education on clinical need qualifications, justification, and regulatory requirements when knowledge gaps are identified for internal associates. Participate in peer review processes to assess the quality of care provided by other clinicians, offering constructive feedback and recommendations for improvement. Analyze and provide feedback to Comfort Medical stakeholders with respect to trends in clinical patient care and identify opportunities for quality improvement. Responsible for keeping Manager informed of deficient audits/appeals, patterns, errors, or other systematic problems identified. Responsible for understanding and adhering to all company and department policies, procedures, and process documents. Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies. Responsible for additional duties assigned by the department’s management.